Urinary incontinence is when a person urinates when they do not want to, usually through everyday activties such as coughing, sneezing, or exercise. It is a very common problem that affects up to one in three women. It may feel embarrassing or distressing.

Stress and urge incontinence is a result of lost or weakened control of the urinary sphincter. The good news is that it may be cured or improved with pelvic floor exercises and lifestyle changes. We recommended that you attempt pelvic floor exercises before considering any surgical treatment; but if these strategies fail, surgery may be recommended for you.

Pelvic floor exercises are most successful if taught to you by a physiotherapist who specialises in pelvic floor dysfunction. Doing regular pelvic floor exercises improves stress incontinence in up to 75% of women and may mean surgery is never required.

On this page you will find information on procedures for the treatment of urinary incontinence including:

Mid-urethral sling (MUS) procedures

Mid-urethral sling procedures (also known as tape or mesh sling procedures) is the most frequently offered operation for stress incontinence. It is a  short procedure that has been performed on more than 3 million women worldwide. Between 80% and 90% of women are happy with their operation (external link)and feel that their incontinence is either cured or much better.

The operation involves placing a 1cm wide sling of permanent polypropylene mesh between the middle portion of the urethra (the tube that drains the bladder) and the skin of the vagina. Placing a sling underneath the urethra improves the support and reduces or stops leaking. The operation may be done as a day procedure or sometimes with an overnight stay following surgery. 

Fascial sling

A fascial sling is a procedure performed to treat female stress urinary incontinence.

Fascial slings are made from the patient's own fascia. The fascia is a layer of strong connective tissue usually obtained from the abdomen (stomach area) or thigh. The surgeon usually takes a strip of fascia 1-3cm wide and places it under the urethra (the pipe through which the bladder is emptied) to give support and reduce leakage of urine.

A fascial sling is considered when other procedures have failed or the patient has concerns about using a synthetic material for their surgery.

Most women stay in hospital for two to three days after a fascial sling but this may be longer if they have issues emptying their bladder. It is recommended to take six weeks off work and exercise.

Colposuspension

Colposuspension (also called burch colposuspension) is an operation that involves placing sutures (stitches) in the vagina on either side of the urethra (pipe through which the bladder empties) and tying these sutures to supportive ligaments to elevate the vagina.

The sutures in colposuspension elevate the vagina and support the urethra, thus reducing or stopping the leakage. Most of the time, colposuspension is performed using an abdominal incision - a horizontal cut in the bikini-line.

Some surgeons may perform the procedure laparoscopically (keyhole surgery). Laparoscopic colposuspension is not currently offered at Auckland City hospital. One year after surgery, more than 80% of women will find that their stress incontinence has either improved or been cured(external link). Twenty years post-surgery, approximately 60% remain satisfied with the outcome.

Most women stay in hospital for two to three days after a colposuspension, but this may be longer if they have issues emptying their bladder. It is recommended to take six weeks off work and exercise.

Urethral bulking

Urethral bulking is a treatment for stress urinary incontinence. It involves injecting a bulking agent into the urethra as it comes out of the bladder through a cystoscope. This narrows the urethra, so leakage is less likely to occur.

Common bulking agents include collagen (a type of protein found in all our tissues) and water-based gels containing various agents.

This procedure is recommended for women:

  • who are not fit enough for more major surgery and anaesthesia
  • who haven't completed their family
  • who do not wish to undergo more invasive surgery for stress incontinence 
  • for whom conventional surgery has not been fully effective
  • whose stress incontinence is due mainly to a deficiency in the sphincter muscle surrounding the urethra.

A top-up injection is often required and the effect of the bulking agent can reduce over time requiring a second injection. This can be done as a day case.

Botulinum Toxin A (BOTA) for Overactive Bladder (OAB)

Overactive Bladder symptoms are caused by the bladder muscle squeezing to empty out urine inappropriately, even when the bladder isn't full. This causes urgency and incontinence. It often happens without warning and when you do not want it to; for example, when hearing the sound of running water, or putting the key into the latch.

Initial treatment involves bladder training exercises with a physiotherapist, and lifestyle changes including relaxation techniques and removing bladder irritants from your diet. There are medications called Anticholinergics that are excellent at calming the bladder muscle and giving you more control. However, if these treatments fail, then BOTA is an option.

BOTA is injected under cystoscopic vision into the bladder muscle. It works by relaxing the muscle of the bladder wall (the detrusor muscle), reducing urinary urgency and incontinence. Following treatment, the effect of the toxins effects last for several months before the muscles return to their normal strength (between three to nine months, occasionally longer).

It is a day-stay procedure and you can return to work once you recover from the anaesthetic (usually after one or two days). It usually requires repeat treatments.